There was no question that an ostensibly liberal pundit was going to come out with loads of praise for the boldness of Paul Ryan’s appallingly regressive, transparentlyfraudulent attack on the Great Society. Whoever had Jacob Weisberg in the pool, collect your winnings! The core of the defense is some inherently reactionary question-begging:

But they’ve been little better than Republicans when it comes to confronting the nation’s long-term fiscal imbalance, which is driven by the projected growth in entitlement spending.

First of all, we have the ages-old routine of conflating Medicare and Social Security spending, although one is a major potential problem and one isn’t. (It won’t surprise you, either, to find out that Weisberg seems to like the idea of “gradually raising the retirement age to 70″ — tolerable for well-compensated journalists, not so much for coal miners and people who clean restrooms for a living.) Second, we have the massive upper-class tax cuts of the aughts mysteriously excluded as sources of fiscal crisis. And third, there’s a failure to recognize the possibility that the alleged problems with Medicare and Medicaid might stem from the fact that America’s “free market” health care system covers fewer people at far greater expense with no better results than any other liberal democracy.

So why does Weisberg like Ryan’s plan to end Medicare?

Ryan’s alternative to Medicare hardly seems as terrible as Paul Krugman makes out. Seniors would enter the health care world the rest of us live in, with co-payments, deductibles and managed care. Eventually, cost control would require some tough decisions about end-of-life care and the rationing of high-tech treatments that have limited efficacy. But starting with a value of $15,000 per year, per senior—the amount government now spends on Medicare—Ryan’s vouchers should provide excellent coverage. His change would amount to a minor amendment to the social contract, not a fundamental revision of it.

Truly remarkable is Weisberg’s blase and almost certainly false assumption that seniors will just be able to purchase insurance on the private market. Why on earth would he believe it? Does he really think it’s uncommon for people over 65 to have medical problems that cost substantially more than $15,000 a year and will either be denied insurance or have to drain their savings or go without needed medical care? Can he really deny that uninsured seniors will become an increasingly greater problem as the vouchers become less valuable, which is they only way money will be saved?

And even if we were to accept Weisberg’s premise that Medicare benefits need to be cut, he utterly fails to justify vourcherizing Medicare, which will increase the ratio of rent-seeking to actual medical benefits while doing nothing to control health care costs. At least with the ACA this indefensible entrenchment of rent-seeking was borne out of the necessity of buying off existing stakeholders given our institutional system. But why on earth would we dismantle an efficient, popular public insurance system that already exists?

And, in addition to the details, we have the remarkable assertion that hammering the poor and middle class to finance upper-class tax cuts is “brave, radical, and smart.” Well, radical I might give you, but Ryan’s plan is the inverse of brave or smart. Unicorn-sighting isn’t a plan and upward transfers of wealth require no courage.

Comments (99)

Historically this was not always the case, but since we have had no domestic tumbrel-production capacity since it was offshored in the ’80, and pitchforks went to Mexico in 2002 when Ames True Temper shut the West Virginia plant, I suppose it’s true.

Just think: an appropriate package of tax advantages, to be given to stick-sharpeners and to stick owners, albeit phased out according to the adjusted gross income of the stick owner, is all we need to trigger a new Jaquerie

If only I could be as brave as Brave Sir Ryan where I propose handing myself huge tax breaks while ensuring that I receive huge praise and tongue baths by the “serious” press corp! Where will we ever see such bravery again?

At 62, Mrs J’s mother had a massive heart attack, her 5 week stay in the hospital with a good health insurance plan cost her close to 60k out of pocket. She is now safely on Medicare. Imagine the same scenario under RyanCare. My guess, the insurance company would take her 15k in vouchers and offer her a plan with a 300k deductible

But it’s hard to make a principled liberal case for the program in its current form. To do so, you have to argue that government-paid health care should be a right only for people over the age of 65, and for no one else.

What? What about Medicaid? Are all the children covered [expanded under Obama] by government-paid health care now not “people”? And, hey, liberals are all for “Medicare for All.” The alternative is not the current reality and Ryan’s plan.

Not surprising though from the same magazine that had a three or four part series railing against Bill Moyers for something he did in the ’60s.

2. The idea behind the voucher system saving costs relies on the idea that consumer driven health will lead to more efficient usage of health care resources. The assumption is incredibly weak because, as Yglesias notes, its already been proven that health care costs are secondary to scoring political points with interest groups.

Anyone who thinks that consumer-driven health will result in savings is as ignorant of economics as of medicine. Health care is, in the main, driven by inelastic demand. People cannot shop around for the best deal when bleeding briskly, and the provider of insulin to a diabetic can charge whatever s/he pleases.

It’s not like this is a hypothetical question. Every other major advanced democracy has socialized or quasi-socialized medicine, and every one delivers better results for less money. The proposition that free markets deliver cheaper healthcare is just empirically indefensible.

But the proposition that similar countries with entirely public health delivery or insurance systems get the same or better care for less money is also empirically sound.

The US has the only health system in the developed world that is not actually a system. No one designed it to operate this way. The unnecessarily high level of spending is one of the consequences of that.

Or on a grander scale, public education itself is a destroyer (or at least weakener) of information asymmetry.

No. Information asymmetries occur when one side of a transaction has better access to information. When that happens one side has more power than the other and the results tend to be either skewed or nonexistent. It is not sufficient for one side to know more, an asymmetry must be a case where one side knows more because of his position.

In health care, for example, the information asymmetry stems from individual health insurance purchasers necessarily know more about their health consumption than insurance companies. Health insurance companies must defend themselves by raising prices above what the customer receives in return or they don’t offer at all.

That is the health insurance death spiral, and there is nothing the government can do to make private estimations of health consumption public. All government can do is appoint health insurance officials to monitor the prices set by other health insurance officials and institute price caps and subsidies accordingly.

So now the information asymmetry is reversed, where the customer has very little understanding of the costs and utility provided, whereas government and business are insiders into the process.

And if you think your vote for Barack Obama is going to sway the tide against the millions coming into buying the favor of unknown bureaucrats, you are crazy.

In health care, for example, the information asymmetry stems from individual health insurance purchasers necessarily know more about their health consumption than insurance companies.

This seems backwards. The amateur knows more than the professionals?

I may know that I have a funny feeling in my knee sometimes, but I have no idea what that actually means in terms of health care outcomes. Even if I don’t disclose it (which I am legally forced to do, anyway, on pain of retroactive rescission of any coverage I may have managed to obtain by not disclosing it), it gives me little if any advantage.

On the other side are statisticians with years of experience at actuarial projection, with all relevant demographic variables and my complete medical history. And they can write the contract in the most opaque legalese they can come up with, so I probably won’t even know what I’m agreeing to or what coverage I actually have until it’s too late for me to do anything about it.

Yeah, I totally have a superior bargaining position there. I pity the poor saps trying to defend themselves with their puny information and expertise against the awesome power of my vague internal feelings!

We have these things called insurance plans which offer different sorts of copays and deductibles, which are both price sensitive and are a constant source of negotiation over price with health care providers.

are a constant source of negotiation over price with health care providers.

In my company, with about 125 employees, exactly 4 negotiate over price with health care providers (“negotiate over price” means that we are given a menu of plans/prices once a year, and get to choose. Insurance companies don’t actually negotiate prices for a plan as small as ours). The other 121 are told what the plan is, what their cost is, and that is it.

This is the biggest thing I don’t get about the plan: are private insurers really going to be in a rush to insure 70 and 80 and 90 year-olds? Absent some massive government regulation forcing down premiums, there’s no way the voucher covers the price of the insurance and so seniors will either go with out insurance or use the voucher to buy some horribly inadequate system.

Uh, no. Not really. Not at all. We docs have very little bargaining power–if we get together and negotiate the insurance companies, we stand a very good chance of being sued or prosecuted for acting in restraint of trade. Add to that that we are responsible, legally and morally, for the well-being of patients, while insurance companies can take actions that would put patients at risk with no liability whatever.

That’s nice, but they’re still very much there. They’re part of the Sherman Anti-Trust Act, and while they are misapplied in the case of physician negotiation, I’d rather not go back to an Upton Sinclair scenario of wholly unregulated corporate M&A, if you please.

What tools do we have to privately police corporate malfeasance? The courts? Class-action suits are a great idea, until some judge that’s chummy with J. Wentworth Corporate-Head decides that the class has not standing, but you’re all welcome to sue individually (and be ground into hamburger by J. Wentworth’s batallions of lawyers). Boycotts? Works nicely, until the corporate kids come to each other’s rescue and preferentially buy the products of the firm being boycotted until the boycott loses steam, or until the firm rebrands its products in an attempt to confuse the boycotting public. The media? Who owns the media outlets, anyway?

The nice thing about government is that it can act as a collective bargaining and enforcement agent for the population, provided the population is paying attention. I’m as down with the anarchist approach as the next guy, but only when the anarchists are promising to dispossess the wealthy of their wealth and smash corporations. Any less, and you’ve introduced a power imbalance so severe that you may as well just advocate a return to feudalism.

corporate greed is capitalism run-a-muck. I don’t believe a person’s health care should be decided by capitalism. There needs to be balance somewhere. I’m tired of this idea that if you say anything bad about capitalism it’s un-american. Is that so no matter where it leads? When did the potential for greed become a value, especially over fairness, mercy and understanding of those in need of health care? Especially mental health care?

The nice thing about government is that it can act as a collective bargaining and enforcement agent for the population, provided the population is paying attention. I’m as down with the anarchist approach as the next guy, but only when the anarchists are promising to dispossess the wealthy of their wealth and smash corporations. Any less, and you’ve introduced a power imbalance so severe that you may as well just advocate a return to feudalism.

I am absolutely fine with that, I have mentioned on several times that government is not abolished until its residual effects are abolished.

I consider that rectification of the power imbalance to be to be valid government activity, if not anarchistic activity in the first place.

You have to understand by now that I fervently believe our corporate landscape is in large part due to the centralized management of government and that I believe the market without government support is not conducive to this sort of big business corporatism.

That’s probably what always happens when an overly anxious So. Illinois farm boy starts to find his politics in more radical places, he turns into a half-assed primitivist.

You have to understand by now that I fervently believe our corporate landscape is in large part due to the centralized management of government and that I believe the market without government support is not conducive to this sort of big business corporatism.

And we keep asking you what would keep oppression from reappearing in your agrarian idyll? Because it pretty much always does except in fantasy fiction. Again, I think most of us would like to live in the Shire or its techno-anarchist equivalent. But power begets power. This is a fact.

I’m not entirely sure that is a universal, it depends alot on social norms.

And we keep asking you what would keep oppression from reappearing in your agrarian idyll?

The two biggest factors would be an increased reliance on community and a return to a social order that is better supported by our moral faculties, and a huge swing in the relationship between labor and capital, as it becomes much harder to pool capital, giving labor a huge boost in value relative to other factors of production.

I see how that could or does work in small communities where you have to look into the eyes of those who are effected by decisions you make. When you start talking about a country with millions of people, most of whom are represented as numbers, it becomes a numbers game. Usually the numbers that get the most attention are the ones beginning with the dollar symbol $

are you saying that doctors have laws limiting their ability to negotiate? I wouldn’t doubt these laws basically make it to where if you disagree with what the insurance companies want you can face legal action. WOW!!! Who regulates the cost of health care? I know doctors spend a lot of time and energy learning so they can treat people and it should pay well, but there’s more to it than just doctor’s salaries. Why does it cost $300 to get stitches and a bandage at the ER? Who decides this stuff?

and just about every choice is non affordable. I don’t care what fancy words you use, if all the choices for health coverage are crap they’re not really choices. It’s basically, “Do I give my right arm to this company, or do I give my leg?” What a choice. The cost of health care is ridiculous.

If single payer is basically the same as the American market system, why wouldn’t Weisberg be in favor of converting the whole system to single payer? It would only be a “minor amendment” after all. Also, since when is it so hard to understand why old people need special care that others don’t? Is he going to question why only children go to school full time next? No, more likely he’ll suggest kids should study on their lunch breaks, in the mines.

Whatever droplets of respect I might once have had for Mr. Weisberg have evaporated, leaving a cold, venomous loathing in their place.

Someone should send Weisberg the chart of uninsured vs. age bracket that shows a steep drop off at age 65 and ask him why he’d rather have seniors live in the crappy world everyone else faces rather than have everyone else join the system seniors have.

He’s set financially, barring any catastrophe, so he doesn’t really care. If it helps keep unneeded money in his pocket, let them die. That’s probably an unfair statement. I of course don’t know him personally. I’m sure that is a shared knee-jerk answer because apparently someone as educated as him would have enough common sense to know all the things that are wrong with his opinion.

I’m beginning to worry that this so-called budget proposal is simply a stalking horse; they have put this mess out there, knowing full well it will never be enacted. What horrible alternative are they saving up? The mind boggles…just when you think the GOP could not become more craven.

You might be right.
But this is truly their greatest hits album of what they want to see in the future, as well as a gutting of SS.

Digby had a great post yesterday about how the Democrats, in their infinite cowardice, will be circling the wagons after this, and falling back around that slightly less radioactive turd, “The Presidents Catfood Commission Report.”

Because the Democrats don’t know how to do understand messages, let alone how to do messaging.

Most of us have been sending them S-O-S’s for years, and they ignore them.
They think we’re telling them everything’s fine because they think S-O-S means, ‘Same Old Shit,’ so, not worries!

And you expect these people to be ready to message?

I have one they can use if they like it:

Democrats – We gave you “The New Deal and “The Great Society” that made this country great!
Republicans want take those back and give you ‘A Raw Deal,’ and ‘A Poor Society!’
It’s your vote. Use it wisely.

I don’t disagree, but has anyone noticed how both parties claim how great their plans are but we never really know what they are sneaking in through the back door let alone able to find any real information on what their plans propose? I hate to sound like a conspiracy theorist, but like a lot of the big corporations that make back door deals when they’re supposed to be offering us competitive pricing, it seems like the dems and repubs only pretend to be at odds. Hell with all the lobbyists and corporate backers do we really think the government didn’t learn a few tricks from their kissing cousins? Who really is in charge here? Well, when they are asked to pay a little more to help the majority out we get blasted with a lot of ridiculous self-justifying rhetoric. Maybe we should start considering a possible bigger picture here guys. I don’t know. Is it really an unfathomable possibility?

I tell you this…I have had a lot of trouble finding information telling me exactly what the republican’s plan b is. When you look for these proposals by government officials all you get is a bunch of hot air and bolstering about how good the plan is with hardly any detail or facts letting you know what the hell they are talking about.

We must hold the Democrats feet to the fire, including Obama’s, to stop the plan by “Privatizing Ryan” and his Conservative Clown Posse.
Hopefully the Democrats will take this opportunity to dig in their heels and say, “Look, we’ve negotiated and capitulated enough. Not another step! PERIOD!!!”

Oh, look, is the Godot on the horizon?

I think I finally figured out why the Conservatives were so adamantly against stem cell research:
They were afraid someone would figure out how to grow spines and infuse Democrats with them.

I’ve touched on this before, but I’ll reiterate my point by asking if anyone realizes how ridiculous most of the plans the democrats and republicans come up with? Eventually they are going to come with a plan that is really going to screw over the majority of people but because all of their previous plans were sooo stupid we see the one they finalize as acceptable. I think they are playing stupid. There’s no way that many people with their collective education couldn’t do better.

That NPR interview with Bob Corker and Max Baucus made me yell at the radio. Corker going on about how the deficit must be cut, without any push-back by the interviewer about his role in pushing through the Obama tax cut for Millionairs, or its consequences. I don’t remember any more why I was yelling at Baucus; I’ll have to replay the interview before leaving feedback for NPR.

The Ryan plan is unpassable, and digby’s 100% correct about where this is headed. The name of the game now is to link the Catfood Commission and the Ryan as different degrees of the same stupid approach–paying for upper class tax cuts with taxes and benefit cuts for the poor and middle class.

Yep! And we need to start following the proverbial money trail and see where it will lead too. That trail should lead right to the same place the puppet strings are attached to that run the government. I wonder if they’re even in this country?

Seniors would enter the health care world the rest of us live in, with co-payments, deductibles and managed care.

WTF world does he live in? I have Medicare, they deduct a premium out of my SSDI check every month for it, I have deductibles that have to be met, I have co-pays that have to met – that’s now, today not in some future he’s talking about. If he had to rely on Medicare for his health care, he’d STFU and quit bitching about what it costs the government (which are my fucking taxes that I paid when I was able to work) and start bitching about what it costs him out-of-pocket and what it doesn’t cover.

If he had to rely on Medicare for his health care, he’d STFU and quit bitching about what it costs the government (which are my fucking taxes that I paid when I was able to work)

No, they’re not. Just like SS, Medicare is a system in which current workers pay to support current retirees. Your taxes paid for my grandpa. Now my taxes pay for you. Someday my nephews’ taxes (or yours, if you have any) will pay for me.

If you had dropped dead at 64, you would have paid for other people all your working life and gotten nothing back — and if you live to 96, you’ll get back much more than you paid in. Which is fine, because dead people don’t need health care and living ones do.

Not to detract from the rest of your criticism, but Medicare is not a savings program.

They’re actually quite different. SS is a fund, separate from the rest of the federal government, that collects money from people while they work and invests it in treasury bonds, and uses the dividends to pay off workers as they retire, in the manner of a fixed-benefit pension program. Medicare is part of the overall federal budget, same as roads or the Navy, which competes for funding to provide health care to the disabled and the elderly. With SS, you have to have paid something into it to get anything back; not so with Medicare, for which eligibility is based on age or disability.

If no more workers paid into SS, there would still be a fund, but it would run out. If all taxes that fund Medicare were stopped, Medicare would cease to exist immediately.

That “future obligation” is US bonds, same as banks and private pension funds invest in. I had a couple myself that my dad bought for me in the ’70s that matured and paid off (not lavish, but helped in med school). If bonds don’t constitute a fund, what would? A room full of gold bullion?

There’s the problem with our whole economy. Everything is paid through basically I.O.U’s Robbing Peter to pay Paul kind of. It’s a joke which we and our future generations will have to pay for the punch line. Punch right to the proverbial balls.

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